Provider Demographics
NPI:1619934510
Name:FITENY, GARY M (DDS PC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:M
Last Name:FITENY
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5635 SASHABAW RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-3149
Mailing Address - Country:US
Mailing Address - Phone:248-620-2933
Mailing Address - Fax:248-620-5055
Practice Address - Street 1:8080 ORTONVILLE RD
Practice Address - Street 2:SUITE A
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-4456
Practice Address - Country:US
Practice Address - Phone:248-620-2933
Practice Address - Fax:248-620-5055
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2016-03-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI29010155041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice